Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
Ophthalmology. 2012 Feb;119(2):294-303. doi: 10.1016/j.ophtha.2011.07.040. Epub 2011 Nov 30.
To investigate the rate of visual field and optic disc change in patients with distinct patterns of glaucomatous optic disc damage.
Prospective longitudinal study.
A total of 131 patients with open-angle glaucoma with focal (n = 45), diffuse (n = 42), and sclerotic (n = 44) optic disc damage.
Patients were examined every 4 months with standard automated perimetry (SAP, SITA Standard, 24-2 test, Humphrey Field Analyzer, Carl Zeiss Meditec, Dublin, CA) and confocal scanning laser tomography (CSLT, Heidelberg Retina Tomograph, Heidelberg Engineering GmbH, Heidelberg, Germany) for a period of 4 years. During this time, patients were treated according to a predefined protocol to achieve a target intraocular pressure (IOP). Rates of change were estimated by robust linear regression of visual field mean deviation (MD) and global optic disc neuroretinal rim area with follow-up time.
Rates of change in MD and rim area.
Rates of visual field change in patients with focal optic disc damage (mean -0.34, standard deviation [SD] 0.69 dB/year) were faster than in patients with sclerotic (mean -0.14, SD 0.77 dB/year) and diffuse (mean +0.01, SD 0.37 dB/year) optic disc damage (P = 0.003, Kruskal-Wallis). Rates of optic disc change in patients with focal optic disc damage (mean -11.70, SD 25.5 ×10(-3) mm(2)/year) were faster than in patients with diffuse (mean -9.16, SD 14.9 ×10(-3) mm(2)/year) and sclerotic (mean -0.45, SD 20.6 ×10(-3) mm(2)/year) optic disc damage, although the differences were not statistically significant (P = 0.11). Absolute IOP reduction from untreated levels was similar among the groups (P = 0.59).
Patients with focal optic disc damage had faster rates of visual field change and a tendency toward faster rates of optic disc deterioration when compared with patients with diffuse and sclerotic optic disc damage, despite similar IOP reductions during follow-up.
研究不同类型青光眼视神经盘损害模式患者的视野和视神经盘变化率。
前瞻性纵向研究。
共 131 例开角型青光眼患者，其中局灶性（n = 45）、弥漫性（n = 42）和硬化性（n = 44）视神经盘损害。
患者每隔 4 个月用标准自动视野计（SAP，SITA 标准，24-2 测试，Humphrey 视野分析仪，卡尔蔡司 Meditec，都柏林，加利福尼亚）和共焦扫描激光断层扫描（CSLT，海德堡视网膜断层扫描仪，海德堡工程有限公司，海德堡，德国）进行检查，为期 4 年。在此期间，根据预设方案治疗患者以达到目标眼内压（IOP）。通过对视野平均偏差（MD）和全局视神经盘神经视网膜边缘区域与随访时间的稳健线性回归来估计变化率。
MD 和边缘区域的变化率。
局灶性视神经盘损害患者的视野变化率（平均 -0.34，标准差 [SD] 0.69 dB/年）快于硬化性（平均 -0.14，SD 0.77 dB/年）和弥漫性（平均 +0.01，SD 0.37 dB/年）视神经盘损害（P = 0.003，Kruskal-Wallis）。局灶性视神经盘损害患者的视神经盘变化率（平均 -11.70，SD 25.5×10(-3)mm(2)/年）快于弥漫性（平均 -9.16，SD 14.9×10(-3)mm(2)/年）和硬化性（平均 -0.45，SD 20.6×10(-3)mm(2)/年）视神经盘损害，尽管差异无统计学意义（P = 0.11）。各组之间的未治疗时 IOP 降低幅度相似（P = 0.59）。
与弥漫性和硬化性视神经盘损害相比，局灶性视神经盘损害患者的视野变化率更快，且视神经盘恶化率有加快的趋势，尽管在随访期间眼压降低幅度相似。
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